The 'concertina effect' and the limitations of current drug-eluting stents: is it time to revisit and prioritize stent design over efficacy?. (June 2012)

• Record Type: Journal Article
• Authors: Shand, James A; Ramsewak, Adesh; Hanratty, Colm G; Spence, Mark S; Walsh, Simon J
• Is Part Of: Interventional cardiology. Volume 4:Number 3(2012)
• Page Start: 325
• Page End: 335
• Publication Date: 2012-06
• Subjects: balloon catch -- longitudinal compression -- stent compression -- stent concertina -- stent design -- stent geometry -- stent thrombosis; Cardiology -- Periodicals; Coronary heart disease -- Treatment -- Periodicals; 616.1205
• DOI: 10.2217/ica.12.27
• Languages: English
• ISSNs: 1755-5310

Abstract

Recently, the phenomenon of longitudinal coronary stent deformation or the 'concertina stent' has been recognized. Bench testing has indicated that this may, in part, be related to stent design. It appears that fewer ring connectors, and in particular their orientation to the longitudinal axis of the stent, may increase the propensity of a stent to distort when traversed by the tip of a guiding catheter, postdilation balloon, further stent or indeed any other adjunctive device. The limited evidence so far indicates that this phenomenon if unrecognized and untreated can result in stent thrombosis, presumably secondary to incomplete stent apposition. Stent design, mechanisms of longitudinal compression and elongation, as well as recognition and management of the phenomenon are discussed.